INDECISIVENESS ABOUT LONG-TERM CARE AMONG OLDER ADULTS

Abstract As cognition and function worsen, older adults often make decisions about living in long term care (LTC) or accepting support in the home. We are longitudinally studying LTC decision-making among a cohort of older adults (65+), who have viewed PlanYourLifespan.org (PYL), a proven-effective LTC planning tool. Subjects were surveyed at baseline (BL), administered PYL, then followed with surveys every 6 months. Participants were asked about LTC decisions in the event of worsening cognition and to describe those decisions. Responses were analyzed using a mixed-methods approach with open-ended responses coded using constant comparative analysis. Of the 293 subjects, mean age was 73 years, 72.7% (213) female, 40.4% (118) under-represented minority. Between baseline-18 months, 66.5% of subjects changed their LTC plans (28.7% one change, 24.23% two changes, 9.2% three changes) At 1 and 6 mos., the proportion of respondents who changed their decision from their prior timepoint was 44%. By 12 mos., this proportion has declined to 39%, and by 18 mos., the proportion further decreased to 34%. Higher indecision (Yes-No-Yes-No) was seen with changes in family caregivers, timing around COVID-19, and personal health. Decision permanence increased at 12-and 18-month time points. LTC decision-making fluctuates; however, over time, the decision-making progresses from circling to more permanence. Understanding LTC decision making is longitudinally important to understand and should be revisited every 6-12 months in clinical practice.

of a larger study on decision making about aging-in-place (R01AG058777), we are longitudinally following a cohort of older adults with surveys every 6 months.Subjects are asked to describe conflicts that have occurred regarding their living situation.Responses were coded using constant comparative analysis examining type, content, and whether statements were interests, rights, or power-based.We enrolled 293 subjects (mean age 73.5 yrs, SD 5 yrs, 40.4% non-White; 94.5% retention rate) and 124 conflicts were reported over 18 months.Thematic analysis revealed three types of conflicts: Interpersonal (subcategories: spouse, intergeneration, other), task, and value-based.Content was coded into 6 themes: Location change, home maintenance issues (e.g., My son insisted I put in a new lower tub, and I didn't want to), different ways of completing tasks (e.g., it is about my children and the way we do things), safety (e.g., Neighbor's boyfriend kicked in the door and destroyed our property), financial, and health-related.Most statements were either interests or rights-based.Older adults experience a range of conflicts involving aging-in-place decision making.Most often older adults experience interpersonal conflicts with supporters about moving from their home or maintaining/ adapting their home.Training in negotiation may help alleviate these conflicts between older adults and their care supporters.

INDECISIVENESS ABOUT LONG-TERM CARE AMONG OLDER ADULTS
Allie Schierer, Amber Miller-Winder, Raven Relerford, Charles Olvera, Vanessa Ramirez-Zohfeld, Alaine Murawski, and Lee A Lindquist, Northwestern University, Chicago, Illinois, United States As cognition and function worsen, older adults often make decisions about living in long term care (LTC) or accepting support in the home.We are longitudinally studying LTC decision-making among a cohort of older adults (65+), who have viewed PlanYourLifespan.org(PYL), a proveneffective LTC planning tool.Subjects were surveyed at baseline (BL), administered PYL, then followed with surveys every 6 months.Participants were asked about LTC decisions in the event of worsening cognition and to describe those decisions.Responses were analyzed using a mixed-methods approach with open-ended responses coded using constant comparative analysis.Of the 293 subjects, mean age was 73 years, 72.7% (213) female, 40.4% (118) under-represented minority.Between baseline-18 months, 66.5% of subjects changed their LTC plans (28.7% one change, 24.23% two changes, 9.2% three changes) At 1 and 6 mos., the proportion of respondents who changed their decision from their prior timepoint was 44%.By 12 mos., this proportion has declined to 39%, and by 18 mos., the proportion further decreased to 34%.Higher indecision (Yes-No-Yes-No) was seen with changes in family caregivers, timing around COVID-19, and personal health.Decision permanence increased at 12-and 18-month time points.LTC decision-making fluctuates; however, over time, the decision-making progresses from circling to more permanence.Understanding LTC decision making is longitudinally important to understand and should be revisited every 6-12 months in clinical practice.

MEASURING MULTIGENERATIONAL NEIGHBORHOODS Martin Hyde, and Elizabeth Evans, Swansea University, Swansea, Wales, United Kingdom
There are growing concerns that societies are becoming more generationally divided and that this is having negative social consequences, such as increasing loneliness and social isolation.Residential age segregation as a key driver of this generational divide and there is worrying evidence that levels of residential age segregation have increased in the USA, UK and Europe.However, measures of age segregation have a number of methodological limitations: i) they only compare younger and older age groups and therefore overlook the wider generational mix in the neighbourhood; ii) different measures of young/older age groups are used in different studies, iii) different geographical scales, e.g.wards, districts, etc., are used in different studies and iv) measures are often at a high level of geographical aggregation, e.g.local authorities.
To address these issues we have developed a new measure of multigenerational neighbourhoods, based on an ecological measure used to calculate biodiversity, for all neighbourhoods in England and Wales from 2011-2020.Our analyses shows that i) there is a low correlation between measures of age segregation and neighbourhood multigenerationality and ii) contrary to some findings on age segregation, the vast majority of people in England and Wales live in multigenerational neighbourhoods.However, some areas have seen a drop in multigenerationality, especially those in inner city and costal areas.

NEIGHBORHOOD DISORDER MODERATES THE EFFECT OF SLEEP DIFFICULTIES ON COGNITIVE DECLINE AMONG OLDER AMERICANS
Darlingtina Esiaka 1 , and Elizabeth Luth 2 , 1. University of Kentucky, Lexington, Kentucky, United States, 2. Rutgers University, New Brunswick, New Jersey, United States Research suggests that the neighborhood where people live can be a risk or protective factor for various health outcomes, including cognitive decline.Similar to the impact of neighborhood on health outcomes, sleep quality has been linked to cognitive functions in older adults.However, limited studies have examined how neighborhood disorders moderate the effect of sleep on cognitive decline.Data were obtained from 2,494 respondents (1,065 men and 1,429 women) from wave 11 of National Health and Aging Trends (NHATS) data.Approximately 55% of the respondents were age 80+, and 74% identified as non-Hispanic White Americans.Sleep quality was operationalized as the absence of difficulties in falling and staying asleep.Neighborhood disorder (e.g., vandalism, graffiti) was based on observations by interviewers.Cognitive decline was operationalized as subjective reports of increasing or worse memory loss in the past 12 months.Moderated regression analysis using PROCESS macro (model 1) was performed to determine the associations between sleep, neighborhood, and cognitive decline.Results showed a significant main effect between neighborhood and cognitive decline (higher levels of neighborhood disorder result in an increase in cognitive decline, B= 0.369, p =.014), but no significant main effect between sleep and cognitive decline.There was a significant interaction between sleep and neighborhood on cognitive decline.Participants who reported higher-than-average sleep difficulties experienced a greater effect of neighborhood disorder on cognitive decline.Our findings could add to inform future health interventions and policy recommendations that can address modifiable sources of cognitive decline.Older adults with Alzheimer's Disease (AD) need additional support in their lifetime, yet little is known about how the decision to accept help is made.Our goal is to better understand how older adults' aging-in-place (AIP) decision making is impacted by worsening cognition, functional loss, social influences, and environmental factors.This longitudinal study consists of older adults from an NIA-funded cohort (LitCog) with extensive cognitive testing.The intervention, PlanYourLifespan.org(PYL), facilitates making decisions about AIP needs, including AD.After viewing PYL, subjects are surveyed every 6 months with cognitive, social, functional, health literacy, environmental and decision-making variables.Of 293 subjects, (mean age 73.5, 72.7% female, 40.4% under-represented minority) almost half (47.4%) experienced cognitive decline with 10.3% identifying worsening memory loss from the prior timepoint.Subjects were asked: If you developed AD, have you decided your living/support preferences?At 1-mo, subjects were significantly more likely to have made decisions if they had: limited health literacy (OR 4.36 [p< 0.01,), larger social networks (OR 1.08 [p< 0.05,), completion of a living will (OR 2.43 [p< 0.05,.At 6-mo, sufficient social support (OR 3.39 [p< 0.05,.At 12-mo, higher social isolation (OR 1.05 [p< 0.05, 1.01-1.08])and self-efficacy (OR 1.07 [p< 0.01,).In the event of worsening cognition, the likelihood of making care decision is associated with external (social support) and internal (self-efficacy, health literacy) variables, which change in significance over time.Catastrophic factors (COVID-19) impacted comfortability of utilizing long-term care facilities.